Card Swipe Solution

Objective

Flexible Spending Accounts (FSA) offer insurance members the ability to have money withdrawn directly from their paychecks into a “holding” account. After paying for medical benefits, the member can submit reimbursement claims to the insurance company, which are then paid out of their account. The drawback to this process is that each member effectively pays for everything twice, until reimbursed money is received.

Direct Debit Swipe Cards were implemented by the insurance company, so that medical payments could be immediately made by the member, deducted directly from the holding account. Each payment still required justification, so a seamless reconciliation process was necessary. DATAMARK was tasked with developing and implementing a method of reconciling submitted receipts required for all “unsubstantiated claims”.

Solution

DATAMARK developed customized software to directly access the Debit Card records of the insurance company. The information was used to identify “card swipes” that constituted unsubstantiated claims so that electronic letters and pre-formatted forms could be automatically generated. The letters were addressed and sent to specific insurance members, requesting certain pieces of substantiating materials to be returned to DATAMARK. Upon receipt of the letter by the member, the member could return all required information to DATAMARK via mail or fax. Both types of returns were received into a newly-developed processing system whereby DATAMARK would reconcile the received information with the original unsubstantiated claim, adjudicate the information, and update the system records of the insurance company so that all data was directly available to them through an on-line environment. The insurance company was also granted secure access to directly interact with our system in order to update information as they would perform direct adjudication from their side.